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. 2024 May 1;72(5):745-747.
doi: 10.4103/IJO.IJO_1205_23. Epub 2024 Feb 23.

Spike sign - To predict the formation of big bubble in deep anterior lamellar keratoplasty in advanced keratoconus

Sharon D'Souza  1 , Rohit Shetty
Affiliations

Spike sign - To predict the formation of big bubble in deep anterior lamellar keratoplasty in advanced keratoconus

Sharon D'Souza et al. Indian J Ophthalmol. .

Abstract

Lamellar surgeries have revolutionized our understanding and practice of keratoplasties. However, the learning curve in deep anterior lamellar keratoplasty (DALK) makes it daunting for novice surgeons. This paper describes a unique intraoperative sign - the radial "spike sign," which heralds the commencement of a big bubble in some cases of advanced keratoconus in eyes that have not undergone any previous surgery. The spike sign was noted during big bubble DALK surgery and was then retrospectively looked for in recorded DALK surgical videos and correlated with the formation of a big bubble. The movement of air after injection was classified into the direct formation of a big bubble, stromal emphysema with no big bubble, and emphysema with the spike sign followed by a big bubble. In total, 104 surgical videos of big bubble attempts were evaluated and classified as such. The spike sign helps reduce the number of unnecessary attempts at big bubble formation during DALK, thus improving surgical outcomes.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Intraoperative microscope view of the cornea showing big bubble formation after air injection. (b and c) Diagrammatic representation of air passage from the needle into the stroma during the formation of a big bubble. (d) Intraoperative microscope view of the cornea showing the stromal emphysema formation after air injection. (e and f) Diagrammatic representation of the air passage from the needle into the stroma during the formation of stromal emphysema. (g) Intraoperative microscope view of the cornea showing the radial spike sign (red arrows) extending outward from the emphysema after air injection. (h and i) Diagrammatic representation of air passage from the needle into the stroma during the formation of radial spike sign. (j) Intraoperative microscope view of the cornea showing type 1 big bubble formation after radial spike sign. (k and l) Diagrammatic representation of big bubble formation from the initial emphysema and radial spikes
Figure 2
Figure 2
(a–d) Intraoperative microscope image of spike formation (red arrow) in four DALK surgeries which just preceded the formation of a big bubble in these cases
See this image and copyright information in PMC

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